title: Robotic-assisted laparoscopic prostatectomy in men with metabolic syndrome.
abstract: OBJECTIVE
  Metabolic syndrome (MetS), the constellation of obesity and related risk factors for cardiovascular disease, is an expanding epidemiologic concern in the United States and the developed world. However, the relationship between MetS and prostate cancer remains to be definitively assessed. We evaluated the association between obesity and MetS with prostate cancer pathology and surgical and functional outcomes.
  
  
  METHODS
  A total of 2,639 patients underwent robotic-assisted laparoscopic prostatectomy (RALP) for localized prostate cancer between March 2003 and July 2012. Of them, 186 patients met the criteria for MetS as defined by the presence of obesity (body mass index [BMI] ≥ 30 kg/m(2)) in conjunction with 2 or more of the following: hypertension (HTN), dyslipidemia (D), and diabetes (DM). Additionally, reference cohorts of (1) 663 nonobese men without HTN, D, or DM; (2) 184 obese patients without HTN, D, or DM; and (3) 211 obese men with solitary risk factors were identified for comparison. Demographic, histopathologic, and perioperative clinical parameters were compared.
  
  
  RESULTS
  In comparison with patients without MetS, patients with MetS had larger prostates (Odds Ratio (OR) = 1.609, 95% Confidence Interval (CI) = 1.04-2.49, P = 0.03), increased blood loss (OR = 1.592, 95% CI = 1.15-2.21, P = 0.01), and surgical complexity (OR = 4.940, 95% CI = 2.29-10.69, P<0.001). There was no statistical difference observed between these groups in regard to complication rates, pathologic grade, stage, and postoperative continence or erectile function. With the exception of larger prostates found among men with MetS, men with obesity alone and obesity with 1 additional risk factor appeared similar to those with MetS.
  
  
  CONCLUSIONS
  Patients with MetS had similar perioperative, histopathologic, and functional outcomes compared with reference cohorts undergoing RALP. RALP is safe, feasible, and efficacious in men with MetS.
authors.affiliation: Department of Urology, The Mount Sinai Medical Center, New York, NY; Mercer University School of Medicine, Macon, GA.
authors.forename: Young Suk
authors.initials: YS
authors.lastname: Kwon
authors.affiliation: Department of Urology, The Mount Sinai Medical Center, New York, NY.
authors.forename: Michael
authors.initials: M
authors.lastname: Leapman
authors.affiliation: Department of Pathology, The Mount Sinai Medical Center, New York, NY; Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Russell B
authors.initials: RB
authors.lastname: McBride
authors.affiliation: Department of Urology, The Mount Sinai Medical Center, New York, NY.
authors.forename: Adele R
authors.initials: AR
authors.lastname: Hobbs
authors.affiliation: Department of Urology, The Mount Sinai Medical Center, New York, NY.
authors.forename: Shemille A
authors.initials: SA
authors.lastname: Collingwood
authors.affiliation: Department of Urology, The Mount Sinai Medical Center, New York, NY.
authors.forename: Kristian D
authors.initials: KD
authors.lastname: Stensland
authors.affiliation: Department of Urology, The Mount Sinai Medical Center, New York, NY. Electronic address: samadiroboticinstitute@gmail.com.
authors.forename: David B
authors.initials: DB
authors.lastname: Samadi
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005240:Feasibility Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications*; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D009929:Organ Size; D011467:Prostate / Q000473:pathology / Q000601:surgery; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000150:complications / Q000601:surgery*; D015203:Reproducibility of Results; D012307:Risk Factors; D012371:Robotics; D016896:Treatment Outcome
keywords: Metabolic syndrome x; Obesity; Prostatectomy; Prostatic neoplasms; Robotics